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In One Ear and Out the Other: How to Improve Patient Recall

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Guest blog post by Robert H. Margolis Professor Emeritus, University of Minnesota Department of Otolaryngology, President, Audiology Incorporated

As health providers, one of our most important jobs is to relay complex information to our patients in understandable and approachable ways. Most of us who provide hearing evaluation services over a long period of time develop a counseling routine to communicate the results and recommendations to our patients.

The Problem With Patient Recall

Explaining findings to patients, however, does not necessInarily mean that they will retain them. Over time, I became increasingly suspicious that my patients’ knowledge and understanding of the information I presented to them had a short half-life – about the amount of time needed to get to the elevator. I discovered that I was not the first person to make this observation and that there was a significant amount of literature on patient recall with contributions from a variety of disciplines. This confirmed my suspicion, and I reviewed the subject for my profession in an article called, “In One Ear and Out the Other – What Patients Remember.” I thought it was a pretty clever title since patients seem to demonstrate consistently faulty memories when recalling results and recommendations from their health providers.

The Link to Patient Satisfaction & Compliance

It turns out that patients aren’t the only people with faulty memories. Health providers are also guilty of this tendency to let information go “in one ear and out the other.” We understand the importance of informational counseling, yet we continue to counsel patients in a way that is unlikely to stick with them. This is not a trivial matter. Studies have found that when patients comprehend information their health providers communicate, there are important increases in patient satisfaction, compliance with recommendations and outcomes, as well as decreases in anxiety, treatment time and cost. The takeaway is that we as health providers must provide information that is important to a patient’s health and well-being in a patient-friendly format. This can serve as a reference and permanent record that can be reviewed and discussed with family members after the visit.

Examples in Action

Here are a couple of experiences that illustrate the problem.

  1. In an informational counseling session with a patient with a longstanding hearing loss who had been tested several times before, I provided the information in a written, illustrated format that communicated the results and recommendations. The patient commented that no one had ever explained his hearing loss to him before. I know the audiologists who had seen him previously, and I know they do an excellent job of explaining results and recommendations. He forgot.
  2. Recently, I referred a friend to a close colleague who is among the most competent audiologists I know. My friend also participated in a research project in my laboratory and I provided written materials explaining her hearing loss. When we were working out next to each other at the club she commented that no one had explained about missing high-frequency sounds like consonants. She forgot.

Communication Strategies for Better Patient Satisfaction & Recall

  • Give advice as concrete instructions. For example, “Use ear plugs when you use your power tools,” rather than, “Keep your noise exposure to a minimum.”
  • Use easy-to-understand language. People remember short words and sentences better, and technical jargon can obscure the message.
  • Emphasize the most important information. Stress the importance of information that you most want the patient to remember. Often this will be a recommendation, such as, “Make an appointment with the ear doctor.”
  • Don’t overload the patient with too much information. Present only the information that is important for the patient to remember. Proportion of retention decreases with the amount of information presented.
  • Use the method of explicit categorization. Tell the patient, “We are going to go over recommendations, then we will talk about your specific problem (diagnosis), then we will go over test results, then we will talk about how your condition may change (prognosis).” Ask the patient for questions before moving on to the next category.
  • Repeat the most important information. If there is any confusion, try to explain it in a different way until the patient understands.
  • Be sure you understand what the patient wants from the evaluation. Ask what his or her desires and beliefs are concerning the problem and address them specifically.
  • Supplement verbal information with written and visual materials that the patient can reference from home. This is the most important strategy of all. Without these materials, your patient will likely remember little from this informational counseling session. Providing the information in a permanent and visual format ensures better recall and better overall quality of care.

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